State insurance mandates- an emerging strategy to increase adoption of new technologies: A case study analysis of the process and impact of HPV testing mandates in California, Maryland, and Texas

Background: Insurance mandate policy has historically been used to increase access to technologies and services for underserved populations. Increasingly, mandates are being considered to increase the adoption of health technologies whether or not access issues exist. Between 2005 and 2007, 6 states (CA, TX, NM, WV, MD, NC) passed legislation mandating private insurers to cover HPV testing within cervical cancer screening coverage policies . Methodology: The process of passing Maryland's SB 779, Texas HB 1485 and California's SB was analyzed to determine common factors of success and to create a framework for analyzing the value of novel mandates. Qualitative interviews were conducted with key stakeholders involved in each bill's passage, identified by cascade sampling techniques. Sale data from the only FDA-approved HPV test were used to measure impact on technology utilization over the period of 1/2005 to 12/2007. Results: The process of passing the mandate was different in each state; however key factors impacting the likelihood of passage across states include evidence levels in support of the technology, cost criteria, reimbursement factors and political conditions. Two of the three states studied experienced prolonged increases in utilization of HPV testing compared to other states after passage of the mandates. Conclusions: The HPV testing case study provides public health professionals with a framework for analyzing the value of novel insurance mandates. The research underscores the question of whether technology adoption rates, as opposed to disease rates, are a valid outcome measure when assessing the impact of mandate policy.